Nonallergic Rhinitis

What Is Nonallergic Rhinitis?

Nonallergic rhinitis describes a set of symptoms that resemble nasal allergies and hay fever but happen without a known cause.

Nonallergic Rhinitis Symptoms

Nonallergic rhinitis causes symptoms that are much the same as the ones you get with allergies, such as:

Nonallergic Rhinitis Causes and Risk Factors

Usually it develops in adulthood, and symptoms last year-round.

Unlike allergic rhinitis, nonallergic rhinitis does not involve the immune system. About 58 million Americans have allergic rhinitis. By comparison, 19 million have nonallergic rhinitis.

Often, what causes nonallergic rhinitis is unknown. And the condition is often confirmed only after other conditions such as allergic rhinitis or infection are ruled out.

Environmental irritants are common triggers of nonallergic rhinitis. Some are found in the home, and others are more common in the workplace.

Examples of what can trigger symptoms include:

  • Car exhaust
  • Chlorine
  • Cigarette smoke
  • Cleaning solutions
  • Glues
  • Hair spray
  • Latex
  • Laundry detergents
  • Metal salts
  • Perfume
  • Smog
  • Wood dust

When such triggers cause nonallergic rhinitis, they often cause asthma, too.

Some medications can trigger non-allergic rhinitis. Examples include:

Foods and beverages may also be triggers. Examples include:

  • Hot foods such as soup
  • Spicy foods
  • Alcoholic beverages, especially beer and wine

Other triggers include:

  • Illegal drugs. Cocaine and other snorted street drugs often cause chronic nonallergic rhinitis.
  • Weather changes. Sudden changes in weather or temperature can trigger nonallergic rhinitis. Skiers, for instance, often develop a runny nose. And some people are affected by any cold exposure. In some cases, people even start sneezing after leaving a cold, air-conditioned room.
  • Hormone changes. Nonallergic rhinitis often happens during periods of hormonal imbalance. For instance, it may happen during puberty, menstruation, or pregnancy. It usually starts during the second month of pregnancy and lasts until childbirth. Hormonal conditions such as hypothyroidism can also trigger symptoms.

Several things can make you more likely to have nonallergic rhinitis:

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Exposure to irritants. Things like tobacco smoke, car exhaust, and smog can raise your chances of nonallergic rhinitis.

Exposure to fumes. Chemicals that give off fumes, such as solvents or paint, can trigger nonallergic rhinitis.

Using decongestant sprays or nose drops. If you use over-the-counter nasal decongestant sprays or drops for more than a few days at a time, your nasal congestion can get worse after they wear off. This is called “rebound congestion.”

Being older than age 20. Nonallergic rhinitis happens in most people after age 20.

Being female. Nasal congestion tends to worsen during your period or when you’re pregnant.

Long-term health problems. Some lingering health problems, such as chronic fatigue syndrome, an underactive thyroid, or gastroesophageal reflux disease (GERD) can cause nonallergic rhinitis or make it worse.

Stress. Both physical and emotional stress can make you more prone to rhinitis problems.

Nonallergic Rhinitis Diagnosis

There isn’t a certain test that tells you if you have nonallergic rhinitis. Your doctor will give you a physical exam and ask you about the symptoms that you have. The only way to be sure that allergies aren’t the cause of your symptoms is with an allergy test. There are two kinds of tests you doctor might order for you:

  • Blood test. This measures the amount of immunoglobulin E (IgE) antibodies in your blood to see if your immune system has had a response to certain allergens.
  • Skin test. Your doctor will prick your skin with a needle and expose it to a small amount of something that causes allergies in many people, such as mold, pollen, or pet dander. If you’re allergic to any of them, you’ll break out in a bump like an insect bite at that place on your skin.

Your doctor will also want to be sure that a problem in your sinuses such as a growth (polyp) or a deviated septum isn’t the cause of your symptoms. To check this, they may order one of 2 imaging tests to look inside your sinuses.

  • Nasal endoscopy. Your doctor will put a narrow fiber-optic tube called an endoscope into your nostrils to look at your sinuses and nasal passages.
  • CT scan: This is a computerized X-ray that makes highly detailed pictures of your sinuses.

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Nonallergic Rhinitis Treatment

Nonallergic rhinitis can't be cured. But it can be controlled by:

  • Avoiding rhinitis triggers
  • Using home remedies such as nasal irrigation
  • Taking over-the-counter and prescription medications

Allergy shots -- immunotherapy -- are not used to treat nonallergic rhinitis.

If you have nonallergic rhinitis, it's important that you not smoke and not allow smoking in your home.

Other strategies to reduce exposure to triggers include:

  • Avoid wood-burning stoves and fireplaces if they cause symptoms
  • Avoid cleaning agents, household sprays, perfumes, and scented products if they cause symptoms.
  • Ask family, friends, and co-workers not to use scented products that cause symptoms.
  • Avoid any chemical or material that tends to make you sneeze or have a runny nose.

Talk to your doctor about the medications you now take. If your nonallergic rhinitis is triggered by a medicine you need, your doctor may suggest a substitute.

Many people with nonallergic rhinitis benefit from performing nasal irrigation. This refers to rinsing of the nostrils with a salt water -- saline -- solution one or more times a day. Over-the-counter products for doing this include bulb syringes, neti pots, and bottle sprayers.

During each irrigation, rinse each nostril with at least 200 mL (about 3/4 cup) of commercially or home-prepared solution.

It's important to note that, according to the CDC, if you are irrigating, flushing, or rinsing your sinuses, use distilled, sterile, or previously boiled water to make up the irrigation solution. It’s also important to rinse the irrigation device after each use and leave open to air dry.

When performed once or twice a day, nasal irrigation may especially help treat postnasal drip. It's also a helpful technique to clear the sinuses before using medicated nasal sprays.

Medications for nonallergic rhinitis include:

  • Nasal antihistamines. Prescription products such as azelastine (Astelin) and olopatadine (Patanase) can relieve symptoms of postnasal drip, congestion, and sneezing within minutes. They’re most effective when used on a regular basis.
  • Nasal glucocorticoids. Daily use of medications such as budesonide (Rhinocort Allergy), fluticasone (Flonase), or triamcinolone (Nasacort Allergy 24HR) may help relieve symptoms. These nasal sprays are available over the counter. It may take days or weeks to notice the full effects. Sometimes, people benefit from using a combination of nasal antihistamines and nasal glucocorticoids.
  • Nasal ipratropium. Ipratropium bromide (Atrovent) is considered the best treatment for the watery nasal discharge that comes from eating and drinking certain foods and beverages.
  • Decongestants. Oral decongestant medications -- such as pseudoephedrine -- may help relieve congestion. But these are not generally recommended unless nasal antihistamines and nasal glucocorticoids don’t help symptoms. Decongestant nasal sprays containing oxymetazoline (Afrin) and phenylephrine (Neo-synephrine) should not be used for more than 2 to 3 days at a time. Doing so can cause overuse (rebound) congestion.

In some cases, surgery to remove nasal polyps or correct a deviated septum can improve the way medications for nonallergic rhinitis work. Surgery is only considered as a treatment by itself, though, when other treatments have failed to reduce symptoms.

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Nonallergic Rhinitis Complications

Nonallergic rhinitis can cause just as much misery as allergic rhinitis. It can also be associated with the same complications, such as:

Both types of rhinitis are associated with:

  • Decreased production at work
  • Increased doctor visits
  • Side effects from treatment, such as drowsiness, nosebleed, and nasal dryness

Because the two are so similar, it's often necessary to perform allergy tests and blood tests to tell them apart.

Nonallergic Rhinitis Prevention

If you have nonallergic rhinitis, you can’t always stop your symptoms, but there are steps you can take to make them less likely to happen:

  • Stay away from your triggers. If you know what things set off your symptoms, you can feel your best by avoiding them.
  • Ease up on using nasal decongestants: You might be tempted to go to them for relief, but if you use nasal decongestant sprays for longer than a few days, your symptoms will come back even worse than before.
  • Talk to your doctor: If your current treatment isn’t working, your doctor can find a new treatment plan that will help.
WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on August 11, 2020

Sources

SOURCES:

American College of Allergy Asthma & Immunology: "Allergic Rhinitis (Hay Fever)."

CDC.

Settipane, R. Allergy Asthma Proc, 2001.

UpToDate.com. “Patient information: Allergic rhinitis (seasonal allergies) (Beyond the Basics).”

Wallace, D. Journal of Allergy and Clinical Immunology, 2008.

Mayo Clinic: “Nonallergic Rhinitis.”         

World Allergy Organization Journal: “Classification of Nonallergic Rhinitis Syndromes With a Focus on Vasomotor Rhinitis, Proposed to be Known henceforth as Nonallergic Rhinopathy.”

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